Volume 58, Issue 12 p. 2329-2336

Stages of Change for the Component Behaviors of Advance Care Planning

Terri R. Fried MD

Terri R. Fried MD

From the * Department of Medicine and § Program on Aging, School of Medicine, Yale University, New Haven, Connecticut; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.

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Colleen A. Redding PhD

Colleen A. Redding PhD

From the * Department of Medicine and § Program on Aging, School of Medicine, Yale University, New Haven, Connecticut; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.

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Mark L. Robbins PhD

Mark L. Robbins PhD

From the * Department of Medicine and § Program on Aging, School of Medicine, Yale University, New Haven, Connecticut; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.

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Andrea Paiva PhD

Andrea Paiva PhD

From the * Department of Medicine and § Program on Aging, School of Medicine, Yale University, New Haven, Connecticut; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.

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John R. O'Leary MA

John R. O'Leary MA

From the * Department of Medicine and § Program on Aging, School of Medicine, Yale University, New Haven, Connecticut; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.

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Lynne Iannone MA

Lynne Iannone MA

From the * Department of Medicine and § Program on Aging, School of Medicine, Yale University, New Haven, Connecticut; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.

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First published: 09 December 2010
Citations: 131
Address correspondence to Terri R. Fried, CERC 151B, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516. E-mail: [email protected]

Abstract

OBJECTIVES: To develop stages-of-change measures for advance care planning (ACP), conceptualized as a group of interrelated but separate behaviors, and to use these measures to characterize older persons' engagement in and factors associated with readiness to participate in ACP.

DESIGN: Observational cohort study.

SETTING: Community.

PARTICIPANTS: Persons aged 65 and older recruited from physician offices and a senior center.

MEASUREMENTS: Stages of change for six ACP behaviors: completion of a living will and healthcare proxy, communication with loved ones regarding use of life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same issues.

RESULTS: Readiness to participate in ACP varied widely across behaviors. Whereas between approximately 50% and 60% of participants were in the action or maintenance stage for communicating with loved ones about life-sustaining treatment and completing a living will, 40% were in the precontemplation stage for communicating with loved ones about quantity versus quality of life, and 70% and 75% were in the precontemplation stage for communicating with physicians. Participants were frequently in different stages for different behaviors. Few sociodemographic, health, or psychosocial factors were associated with stages of change for completing a living will, but a broader range of factors was associated with stages of change for communication with loved ones about quantity versus quality of life.

CONCLUSION: Older persons show a range of readiness to engage in different aspects of ACP. Individualized assessment and interventions targeted to stage of behavior change for each component of ACP may be an effective strategy to increase participation in ACP.